Comparison between transradial and transfemoral access for carotid artery stenting performed by vascular surgeons

Background: The aim of this paper was to compare the patient characteristics, procedural details, 30-day postoperative outcomes of carotid artery stenting (CAS) performed through radial access versus femoral access. Methods: This is a single-center, retrospective, non-randomized study conducted on 613 consecutive patients who underwent elective CAS between January 2015 and January 2025. Patients were divided into two groups based on access route: radial (N.=167) and femoral (N.=446). The following were considered as the primary endpoints: 1) the occurrence of one of TIA/stroke/death; and 2) the overall perioperative complications rate. Secondary endpoints included access-site complications, procedure duration, and single complication rate. Results: No significant differences were observed between the two groups in pre/intraoperative variables, except for the rate of symptomatic carotid stenosis (radial 22% vs. femoral 15%, P=0.030) and the use of dual-layer stents (radial 87% vs. femoral 75%, P<0.001). The TIA/Stroke/death rate (radial 1.8% vs. femoral 4.4%, P=0.119), overall perioperative complication rate (radial 5.4% vs. femoral 10%, P=0.057), and access-site complications (radial 0.6% vs. femoral 2%, P=0.217) were comparable between groups. However, the mean procedure time was significantly shorter in the radial group (36±15 minutes vs. 42±18 minutes, P<0.001). Conclusions: Percutaneous radial access in CAS procedures was more frequently performed in symptomatic patients and with the use of newer low-profile dual-layer micromesh platforms. Radial access was associated with shorter procedural times and a trend toward lower perioperative complication rates, though the latter did not reach statistical significance.